Preconception Care for Black Communities

Guidance for Health Care Providers

Key Messages for Providers

  • Preconception care is an important opportunity to address inequities in maternal and perinatal outcomes experienced by Black communities.
  • In Canada, Black patients experience disproportionately higher rates of adverse maternal outcomes, including severe maternal morbidity and mortality. These disparities are largely driven by structural racism, social determinants of health, and inequitable access to care, rather than biological differences.
  • Preconception encounters provide an upstream opportunity to identify risk, optimize health before pregnancy, and build trusting relationships that support ongoing engagement with care.

Why Equity Matters in Preconception Care

Health outcomes for Black Canadians are influenced by social and structural determinants such as:

  • Income insecurity
  • Employment conditions
  • Housing stability
  • Educational access
  • Experiences of racism within and outside health systems

Structural racism can influence chronic stress exposure, access to preventive care, and the quality of clinical interactions.

Preconception care provides an opportunity to identify risk early, address access barriers, and strengthen continuity of care before pregnancy occurs.

Clinical Pearl: Trust-building is a protective intervention. Respectful communication, continuity of care, and acknowledgement of barriers can improve engagement with care and ultimately improve health outcomes.

Core Clinical Principles

Equitable preconception care should emphasize:

  • Proactive and longitudinal care
  • Trauma- and violence-informed approaches
  • Culturally safe communication
  • Patient-centred shared decision-making
  • integration of medical and social risk assessment

Providers play a key role in reducing inequities through respectful communication and equitable access to preventive care.

Routine Screening and Assessment

Preconception visits should include assessment of both medical risk factors and social determinants of health.

Screening should be:

  • Routine
  • Non-judgmental
  • Repeated over time
  • Independent of pregnancy intention

Areas to assess include:

  • Chronic health conditions
  • Mental health and psychosocial stress
  • Barriers to accessing care
  • Housing and financial insecurity
  • Experiences of discrimination or prior negative health care encounters

Common Barriers Affecting Preconception Care

Patients from Black communities may experience barriers that affect access to and engagement with care.


Common barriers include:

  • Delayed or inconsistent access to primary care
  • Fragmented health services and limited continuity of care
  • Prior experiences of dismissal or minimization of symptoms
  • Financial barriers such as transportation or unpaid time off work
  • Immigration-related barriers or gaps in health coverage
  • Mistrust related to historical and ongoing harms in health systems

Recognizing these barriers allows providers to tailor care and improve access.

Core Clinical Priorities

Chronic Disease Optimization

Certain chronic conditions, including hypertension and diabetes, are more prevalent in some Black communities and are important contributors to pregnancy risk.

Key Preconception Actions
  • Screen regularly for chronic conditions
  • Optimize disease control prior to pregnancy
  • Review medication safety for pregnancy
  • Establish realistic and accessible follow-up plans

Mental Health and Psychosocial Stress

Chronic stress, including stress related to racism and discrimination, can influence physical and mental health.

Key Preconception Actions
  • Screen for depression and anxiety
  • Ask about psychosocial stressors
  • Use open, neutral language when discussing mental health
  • Connect patients with mental health or community supports when needed

Reproductive Life Planning and Autonomy

Preconception counselling should support informed and autonomous reproductive decision-making.

Key Preconception Actions
  • Ask about reproductive goals without assumptions
  • Provide counselling about pregnancy planning and contraception
  • Encourage folic acid supplementation and health optimization prior to pregnancy
  • Support shared decision-making regarding pregnancy timing

Communication and Trust-Building

Culturally safe communication improves patient engagement and continuity of care.

Helpful conversation prompts include:

  • “What has your experience with health care been like so far?”
  • “Are there any barriers that have made it harder to access care?”
  • “What matters most to you as you think about your future health or pregnancy plans?”

Listening to patient experiences and acknowledging barriers can strengthen therapeutic relationships.

Referral Pathways and Resources

Community-based and multidisciplinary supports play an important role in reducing health inequities.

Consider referral to:

  • Primary care or internal medicine for chronic disease management
  • Mental health services that provide culturally safe care
  • Social work for financial, housing, or insurance support
  • Community organizations supporting Black communities

Connecting patients with appropriate resources can improve continuity of care and health outcomes.

Practical Clinical Actions

Equitable preconception care can be integrated into routine visits.

At routine visits, consider:

  • Ask about reproductive goals
  • Screen for chronic disease and mental health conditions
  • Assess social determinants of health
  • Ask about barriers to accessing care
  • Provide patient-centred counselling and shared decision-making
  • Connect patients with community supports
  • Arrange follow-up care

Small changes in routine clinical encounters can meaningfully improve preconception health outcomes.

Key Steps for Equitable Preconception Care

Step

Clinical Action

Screen for social determinants of health

Assess housing, income and access barriers

Assess chronic conditions

Screen for hypertension, diabetes, obesity and mental health

Address racism and bias

Engage in self-reflection and provide culturally safe care

Provide navigation support

Connect patients with community resources

Review medications and immunizations

Optimize prior to conception

Screen for intimate partner violence

Provide support and referral when needed

Refer as appropriate

Mental health, chronic disease and community services

Resources for Health Care Providers

To support equitable, culturally safe preconception care for Black patients, the following resources provide clinical guidance, education, and community-based supports.

SOGC HUB

Trauma- and Violence-Informed Care HUB
A resource hub that provides information, tools, and learning resources to support trauma and violence-informed practice in health care.

Online Courses

Trauma and Violence-Informed Care
An SOGC online course that builds knowledge and practical skills in trauma- and violence-informed care to support safer, more effective patient care.

Websites

Minocare
A Canadian perinatal care resource hub that provides culturally safe, anti-racist, patient-centred services, education, and support from preconception through the postpartum period.

Black Physicians of Canada
A national organization that provides advocacy, mentorship, and resources to support Black physicians, learners, and equitable health care in Canada.

Centre for Addiction and Mental Health – Black Mental Health Resources
A CAMH resource page that curates Black mental health services, toolkits, and community supports to help connect people with culturally relevant care and resources.

National Collaborating Centre for Determinants of Health
A Canadian public health resource that outlines leadership competencies to support effective public health practice in Canada.

Resources for Patients

Endometriosis Resources for the African, Caribbean, and Black Community
An SOGC resource collection that provides endometriosis information and support resources tailored for African, Caribbean, and Black communities.

Preconception Health for Black Communities
An SOGC and Black Physicians of Canada resource that highlights preconception health considerations for Black individuals and communities and supports informed, culturally responsive care.

A Guide to Your Preconception Health Appointment
An SOGC and Black Physicians of Canada resource that helps Black individuals and communities prepare for preconception care appointments and support informed, culturally responsive conversations.

The Society of Obstetricians and Gynaecologists of Canada (SOGC)